Avoid being seen as the enemy

Most incidents of intimidation of risk managers emanate from a lack of understanding of the role of the risk manager in the hospital or health system, poor communication, and an absence of clarity regarding chain of command, says Patrick Hurd, JD, senior counsel and leader of the Healthcare Industry Group with the law firm of LeClair Ryan in Norfolk, VA.

Often, confrontations occur between physician and nursing staff who consider risk managers the enemy, spies, and even "the goon squad," he says.

"I actually heard that term from a colleague," Hurd says. "Because physicians and nurses are sources of revenue for the hospital, and risk managers are overhead, hospital administration may be reluctant in some instances to defend the risk manager."

The best way to counter such issues is for the risk manager to be visible on the floors and communicate with departments when there is not a risk incident, i.e., when everything is fine, he says. This will enable employees to get comfortable with the risk manager's true role and to foster an "I've got your back" atmosphere," he says.

"If the risk manager stays in the office doing claims management and only appears on the floors to investigate an adverse event, such conduct leads to the negative caricatures," he says. "Also, keeping those up the chain of command aware of your activities, focusing on preventive programs and processes using a collegial buy-in approach can bring dividends in the long run. It's also helpful to know when to 'pick your fights.'"

Also, if your organization is prone to killing the messenger, make sure you are really supposed to deliver that message. Risk managers preparing to deliver bad news should understand the exact nature of their roles within the health care organization and the protections afforded them by corporate policy, says Pamela Verick, director and solution leader for fraud risk management with the Vienna, VA, office of Protiviti, a global business consulting and internal audit firm.

The specific responsibilities of a risk manager will differ from one organization to the next, and that includes what reportable issues are the direct responsibility of the risk manager vs. some other departments, such as human resources or compliance, Verick says. Knowing those distinctions can help keep you from putting your head on the chopping block unnecessarily, she says.

"Depending on the reporting line, the risk manager's responsibility may be to provide the information to legal counsel, for instance, if the matter is privileged, and then counsel would escalate that matter to the board," she says. "That provides some insulation, rather than getting caught up in unfortunate situations with management."

The risk manager also should be familiar with the protections afforded not only by federal and state law, but also by the organization's own policies, Verick says. For a risk manager, those policies are the first line of defense when facing professional intimidation, she says.


• Patrick Hurd, JD, Senior Counsel, LeClair Ryan, Norfolk, VA. Telephone: (757) 441-8931. E-mail: patrick.hurd@leclairryan.com.

• Pamela Verick, Director and Solution Leader, Fraud Risk Management, Protiviti, Vienna, VA. Telephone: (571) 382-7243. E-mail: pam.verick@protiviti.com.